Raventós Clara, Barahona Fabricio, Riambau Vicente
Vascular Surgery Department, Cardiovascular Institute, Hospital Clínic Barcelona, University of Barcelona, Spain.
EJVES Vasc Forum. 2025 May 9;64:66-70. doi: 10.1016/j.ejvsvf.2025.05.004. eCollection 2025.
EndoAnchors are adjuncts used for the prevention and treatment of type I endoleak and graft migration in thoracic or abdominal endovascular aortic aneurysm repair in patients with a challenging aortic neck. They secure the stent graft mechanically to the aortic wall by means of metallic screws. Adverse events are infrequent; however, the most common ones are fracture and or dislodgment (0.3-0.9%) and applicator malfunction (0.3%), as observed in this case.
A 77 year old woman showed symptoms of increasing interscapular chest pain for three months. A computed tomography angiography scan revealed a large and symptomatic ascending thoracic aortic aneurysm with extension to the arch and descending thoracic aorta. The patient was operated on urgently using a frozen elephant trunk technique, with pain cessation. The residual thoracic aneurysm was repaired six months later with two overlapped thoracic endografts placed 15 mm above the celiac trunk and distal EndoAnchors, an off label use, due to a severely angulated distal landing zone. During the seventh and last EndoAnchor deployment on an angulated surface, a malfunction of its applicator was detected, which caused EndoAnchor detachment and migration, flying into the aorta's lumen and landing close to the aortic wall below the graft. It was then trapped with a CloverSnare four loop vascular retriever (CookMedical, Bloomington, IL, USA), supported by an 8.5 F TourGuide steerable sheath. During extraction, it fractured into two pieces at the common iliac artery. The previous manoeuvre was repeated at this level, recovering the fractured piece. Final completion angiography showed a good result without endoleak. The immediate post-operative and follow up scans were uneventful.
EndoAnchor detachment is uncommon but when it does occur, it is a solvable issue and can be retrieved using a snare and extracted with the proper endovascular tools and expertise.
EndoAnchors是一种辅助装置，用于预防和治疗具有挑战性主动脉颈部的患者在胸主动脉或腹主动脉瘤腔内修复术中的I型内漏和移植物移位。它们通过金属螺钉将支架移植物机械固定在主动脉壁上。不良事件并不常见；然而，最常见的是骨折和/或移位（0.3 - 0.9%）以及施药器故障（0.3%），本病例即观察到这种情况。
一名77岁女性出现肩间区胸痛加重症状三个月。计算机断层血管造影扫描显示一个巨大且有症状的升主动脉瘤，延伸至主动脉弓和降主动脉。患者紧急接受了冷冻象鼻技术手术，疼痛缓解。六个月后，由于远端着陆区严重成角，使用两个重叠的胸段腔内移植物在腹腔干上方15毫米处和远端EndoAnchors修复残余胸主动脉瘤，这属于一种非标签使用情况。在第七次也是最后一次在成角表面部署EndoAnchors时，检测到其施药器出现故障，导致EndoAnchors分离并移位，飞入主动脉腔内并落在移植物下方靠近主动脉壁的位置。然后用一个CloverSnare四环血管回收器（美国伊利诺伊州布卢明顿市库克医疗公司）将其捕获，该回收器由一个8.5F TourGuide可操纵鞘管支撑。在取出过程中，它在髂总动脉处断裂成两块。在该水平重复先前的操作，取出了断裂的碎片。最终的造影显示结果良好，无内漏。术后即刻和随访扫描均无异常。
EndoAnchors分离并不常见，但一旦发生，这是一个可解决的问题，可以使用圈套器取出，并借助适当的血管内工具和专业知识进行提取。
